What is Medicaid? +

Medicaid is low-cost or free health insurance that can help you get the care you need and protects you from large medical bills. It covers doctor visits, hospital care, prescriptions, mental health care, and more. Medicaid health insurance typically covers lower-income children and families, seniors and people with disabilities, and pregnant people. In states that have expanded Medicaid, lower-income adults without children whose household income falls below 133% Federal Poverty Level can also qualify. Medicaid should not be confused with Medicare, which is a federal health insurance program open to all people in America over the age of 65, certain people under the age of 65 with disabilities, and people with End-Stage Renal Disease (ESRD).

Medicaid and the Children’s Health Insurance Program (CHIP) are often different programs with different eligibility rules.

For more detailed information on different programs, as well as to learn more about how to apply, go to Medicaid or Healthcare.gov or call 1-800-318-2596.

What does Medicaid cover? +

Medicaid covers doctor visits, hospital visits, prescriptions, immunizations, mental health care, x-rays and lab tests, vision and hearing care, family planning services, treatment of special health needs and pre-existing conditions, and more.

To see a full list of health care services covered, visit Medicaid or Children’s Health Insurance Program (CHIP)

If I applied to Medicaid before and was denied, can I apply again? +

Yes. You can apply for Medicaid for yourself or a family member at any time, even if you’ve been previously denied.

Medicaid eligibility is based on an individual’s or family’s current circumstances. Anyone’s circumstances can change. Maybe you lost a job or some income because of the COVID-19 pandemic. Or perhaps you are newly pregnant. Medicaid eligibility is also based on monthly income. If a person’s income changes from month to month, they could be eligible. As life changes, Medicaid may help.

What is the Health Insurance Marketplace? +

The Marketplace is a service that helps people shop for and enroll in health insurance. The federal government operates the Health Insurance Marketplace, available at HealthCare.gov, for most states. Some states run their own Marketplaces.

The Marketplace provides health plan enrollment services through websites, call centers, and in-person help.

What do health insurance plans on the Marketplace cover? +

All plans offered in the Marketplace cover these 10 essential health benefits.

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services (including behavioral health treatment)
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Plans must also include birth control and breastfeeding coverage.

Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements.

What if I have a pre-existing medical condition? +

All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.

Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.

Medicaid and the Children’s Health Insurance Program (CHIP) also cannot refuse to cover you or charge you more because of your pre-existing condition.

Can I get financial help to pay for health coverage through the Marketplace? +

Yes, what you pay for your health insurance is dependent on your income. You may qualify for a premium tax credit that lowers your monthly insurance bill, and for extra savings on out-of-pocket costs like deductibles and copayments.

Has there been an update to the public charge rule? +

The Trump Administration's public charge rule is permanently blocked, nationwide. As of March 9, 2021, the Biden Administration decided to stop defending lawsuits challenging the Trump-era public charge regulations. Federal courts reacted immediately, dismissing the government's appeals. This means that the final judgment entered in the Northern District of Illinois on Nov 2, 2020, which vacated the public charge rule nationwide is now in effect.

What does this mean? +

The Trump-era public charge regulations are no longer in effect. DHS/USCIS will follow the policy in the 1999 Interim Field Guidance. Under this policy, it is safe for immigrants and their families to access health, nutrition, and housing programs for which they are eligible.

As an immigrant, do I qualify for Medicaid? +

Many people are eligible for Medicaid, including non-citizens who are “lawfully present” in the United States. Most qualified non-citizens, such as many Legal Permanent Residents (LPRs) or green card holders, who meet state Medicaid and CHIP eligibility rules can enroll in these programs after being in the United States for five or more years. This means they must wait five years after receiving "qualified" immigration status before they can get Medicaid and CHIP coverage. There are exceptions to the five year wait period, including for refugees, asylees, or LPRs who used to be refugees or asylees.

The term “qualified non-citizen” includes:

• Lawful Permanent Residents (LPR/Green Card Holder)
• Asylees
• Refugees
• Cuban/Haitian entrants
• Paroled into the U.S. for at least one year
• Conditional entrant granted before 1980
• Battered non-citizens, spouses, children, or parents
• Victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa
• Granted withholding of deportation
• Member of a federally recognized Indian tribe or American Indian born in Canada
• In addition, Medicaid may cover emergency medical services for people who meet all state Medicaid requirements (i.e., state residency and income limits) but do not have an eligible immigration status. Documentation of the emergency is usually required.

Source: https://www.healthcare.gov/immigrants/lawfully-present-immigrants/

What is the continuous coverage requirement and why is it ending? +

At the start of the COVID-19 pandemic in early 2020, Congress put into place protections for Medicaid enrollees to ensure that they were able to keep their health coverage during the crisis. This policy was called continuous coverage and was originally linked to the COVID-19 Public Health Emergency, or PHE, another federal government declaration.

However, a spending bill passed in December 2022 severed this link and determined that April 1, 2023 would be the end of continuous coverage, regardless of whether the PHE remains in effect. In April 2023, states can begin the process of “unwinding” the continuous coverage requirement by reviewing the eligibility of every person enrolled in Medicaid in the state. Now, millions of people are at risk of losing their health coverage. Consistent, clear, and accessible community outreach and education is essential to help Medicaid enrollees and their families stay covered.

How long will states have for the unwinding period? +

Beginning April 1, 2023, states will be able to terminate enrollment for ineligible individuals enrolled in Medicaid, following a redetermination period. States must initiate renewals for all individuals enrolled within 12 months (i.e., by March 31, 2024) and must complete renewals for individuals enrolled within 14 months (i.e., by May 31, 2024).

States must submit their renewal redistribution plans to CMS by February 15, 2023 and are required to report specific progress metrics on the 8th of each calendar month throughout the unwinding period. Each state’s process of “unwinding” will vary based on their specific plans.

Who is at risk of losing their Medicaid coverage? +

This upcoming renewal may be particularly challenging for enrollees due to the high number of cases. People particularly at risk of losing their coverage include:

• Those who have moved during the pandemic and have not updated their mailing address or other contact information with the state.
• Those who receive renewal information from the state but do not return it in time, perhaps because they are not familiar with the process after not completing a renewal over the past few years.
• Enrollees who live in one of the 11 states that have not expanded Medicaid.

What can advocates do now to inform & educate enrollees about the upcoming change? +

The landscape around the continuous coverage requirement has continued to shift and the “Public Health Emergency” language remains confusing to many. Advocates should use simple and consistent messaging to let enrollees know that rules are changing and that it could impact their health coverage. From message testing, we found that emphasizing “the Medicaid rules are changing on April 1, 2023 and everyone must renew” resonated with enrollees and provided them with the information they needed.

Advocates should also include concrete action items for enrollees whenever possible. For example, materials should direct individuals to update their contact information and address so they do not miss any important notices from their state Medicaid agency.

Lastly, advocates can connect with their state Medicaid agencies to understand the specific details of the renewal process in their state and communicate that with community members.